Chapter 15 Psychological Disorders

Psychological Disorders 1. Defining and Explaining Abnormal Behavior 1. Abnormal Behavior 1. behavior that is deviant, maladaptive or personally distressful over a relatively long period of time 2. 3 Criteria for distinguishing abnormal behavior: 1. Deviant 1. behavior does not conform to social standards 1. ex. a woman washing her hands four times an hour and taking seven showers a day 2. context of a behavior can determine if it is deviant or not 1. ex. if the woman washing her hands 4x a day and showering repeatedly works in a sterile lab w/ live viruses or radioactive material, her behavior might be acceptable 2. Maladaptive 1. behavior that interferes w/ a person's ability to function effectively in the world 1. ex. a man who believes his breathing could endanger people may go to great lengths to avoid people 3. Personal distress over a long period of Time 1. ex. a woman making herself vomit after every meal 3. Only one of the three criteria needs to be present for behavior to be abnormal 4. When abnormal behavior persists it may lead to the diagnosis of a psychological disorder 2. Theoretical Approaches to Psychological Disorders 1. Biological Approach 1. attributes psychological disorders to organic, internal causes 2. primarily focuses on the brain, genetic factors and neurotransmitter functioning as the sources of abnormality 3. Medical Model 1. describes psychological disorders as medical diseases w/ a biological origin 2. Psychological Approach 1. emphasizes contributions of experiences, thoughts, emotions and personality characteristics in explaining psychological disorders 3. Sociocultural Approach 1. emphasizes social contexts in which a person lives, including culture 1. culture establishes the norms by which behavior is evaluated and decides if it is socially acceptable 2. culture norms can be limiting, oppressive and prejudicial however and so individuals who fight to change established social orders can be labeled deviant/mentally ill 1. ex. women suffragettes 2. stresses the ways cultures influence the understanding/treatment of psychological disorders 3. frequency/intensity of psychological disorders vary/depend on social, economic, technological and religious aspects of cultures 4. Biopsychosocial Model 1. Abnormal behavior can be influenced by biological, psychological and sociocultural factors like genes, childhood experiences and gender 1. factors can act alone or w/ one another 2. from biopsychosocial perspective, none of the factors is viewed as more important than another 1. all are significant in producing normal/abnormal behavior 2. Vulnerability-Stress hypothesis 1. aka diathesis-stress model 2. important concept that has helped psychologists understand the ways different factors influence development of psychological disorders 3. suggests that preexisting conditions (like genetic characteristics, personality dispositions or experiences) may put a person at risk of developing a psychological disorder 1. this vulnerability in combo w/ stressful experiences can lead to psychological disorder 3. Classifying Abnormal Behavior 1. DSM Classification System 1. Diagnostic and Statistical Manual of Mental Disorders 1. DSM-5 most current version 2. # of diagnoses has increased dramatically 1. ex. binge eating disorders and gambling addiction 2. not only diagnostic system 1. World Health Organization- International Classification of Diseases and Related Health Problems (ICD-10) 2. Critiques of the DSM 1. DSM criticized on # of bases 1. central criticism applies to all DSM versions 1. it treats psychological disorders as if they are medical illnesses, taking overly biological view of conditionals that may have roots in social experience 2. continues reflecting medical model neglecting factors like poverty, unemployment and trauma 2. focuses strictly on problems 3. relies too much on social norms/subjective judgments 4. too many new categories of disorders have been added, some of which don't have consistent research support and would lead to significant increase in # of people being labeled as having a mental disorder 5. loosening standards for some existing diagnoses will add to already very high rates of these 3. Autism Spectrum Disorder 1. refers to range of neurodevelopmental disorders involving impaired social interaction and communication, repetitive behavior and restricted interests 2. refers to a range of symptoms w/ no single identified cause for the disorder 1. Numerous complex causes: 1. genetic and neurological factors 4. Somatic Symptom Disorder 1. Somatoform Disorder (formerly called) 2. person experiences one or more bodily (somatic) symptoms and experiences excessive thoughts/feelings about these symptoms 1. first, involves person experience physical symptom like chronic pain 2. focus now is on experience of distressing thoughts/ feelings related to symptoms 3. Attention Deficit/Hyperactivity Disorder (ADHD) 1. common psychological disorder in which individual exhibits one or more of the following: 1. inattention 2. hyperactivity 3. impulsivity 2. Anxiety and Anxiety Related Disorders 1. Anxiety Disorders 1. involves fears that are uncontrollable, disproportionate to the actual danger the person might be in, and disruptive of ordinary life 2. feature motor tension (jumpiness), hyperactivity (dizziness) and apprehensive expectations and thoughts 3. DSM-5 recognizes 12 types of anxiety disorders 1. 4 of the most common: 1. Generalized Anxiety Disorder 2. Panic Disorder 3. Specific Phobia 4. Social Anxiety Disorder 2. 2 disorders not classified by DSM-5 as anxiety disorders 1. Obsessive Compulsive Disorder 2. Post-Traumatic Stress Disorder 2. Generalized Anxiety Disorder 1. anxiety disorder marked by persistent anxiety for at least 6 months and in which the individual is unable to specify the reason for the anxiety 2. sufferers are nervous most of the time and worry a great deal 1. worrying can take a physical toll and can cause fatigue, muscle tension, stomach problems and difficulty sleeping 3. Biological Factors can be: 1. genetic predisposition 2. deficiency in the neurotransmitter GABA 3. respiratory system abnormalities 4. problems in regulating the sympathetic nervous system 4. Psychological/Sociocultural factors include: 1. having harsh/impossible self standards 2. overly strict, critical or cold parents 3. automatic negative thoughts when stressed 4. a history of uncontrollable traumas/stressors (abusive parents) 3. Panic Disorder 1. anxiety disorder in which individual experiences recurrent, sudden onsets of intense terror, often without warning and w/ no specific cause 2. can produce: 1. severe palpitations 2. extreme shortness of breath 3. chest pains 4. trembling 5. sweating 6. dizziness 7. helpless feelings 3. Biological Factors include: 1. genetic predisposition to the disorder 2. genes that direct action of neurotransmitters like norepinephrine, GABA and serotonin 3. Lactate(places role in brain metabolism) is elevated 1. increasing lactate levels can produce panic attacks 4. Biological Factors appear to share biological characteristics w/ physical illnesses like asthma, hypertension and cardiovascular disease 5. Psychological Influences 1. learning processes are a factor considered in panic disorders 1. learned associations between bodily cues of respiration and fear can play a role in panic attacks 2. generalization may apply to panic attacks 6. Sociocultural Factors 1. Women are nearly 2x as likely to have panic attacks 1. possible reasons include biological differences in hormones/neurotransmitters 1. also different ways men/women cope w/ anxiety provoking situations 4. Specific Phobia 1. an anxiety disorder in which an individual has an irrational, overwhelming persistent fear of a certain object/situation 2. fear becomes a phobia when a situation is so dreaded an individual goes to almost any length to avoid it 1. phobias might be viewed as extreme/unfortunate variants on the adaptive process of fear 2. women are more likely than men to experience specific phobias 5. Social Anxiety Disorder (SAD) 1. aka social phobia 2. intense fear of being humiliated/embarrassed in social situations 3. Genes play a role along w/ neural circuitry involving the thalamus, amygdalae and cerebral cortex 1. # of neurotransmitters like oxytocin may be involved 4. may involve vulnerabilities like: 1. genetic characteristics 2. overprotective/rejecting parenting 3. learning experiences in a social context 5. individuals w/ SAD feel their anxiety prevents them from letting others know who they really are 6. Obsessive-Compulsive Disorder 1. psychological disorder involving anxiety provoking thoughts that won't go away and/or urges to perform repetitive, ritualistic behaviors to prevent/produce some future situation 2. Obsessions-recurrent thoughts 3. Compulsions-recurrent behaviors 1. ex. excessive checking, cleansing and counting 4. Biological Factors Contributing to OCD 1. May be genetic component 2. may also be low levels of neurotransmitters serotonin and dopamine and high levels of glutamate in brain pathways linked w/ OCD 3. Neurological Links 1. brain seems to engage in hyperactive monitoring of behavior in relation to OCD 2. brain activation during learning may predispose individuals w/ OCD to chronic feeling that something isn't right 3. frontal cortex or basal ganglia are so active in OCD that #ous impulses reach thalamus and generate obsessive thoughts/compulsive actions 5. Psychological Factors 1. Learning processes implicated in OCD 1. person w/ OCD behaviors often feels doing something is an important way to fend off a dreaded outcome 2. avoidance learning might be important contribution to maintenance of compulsive symptoms 3. individuals w/ OCD show cognitive bias associated w/ overestimating threats, especially when they're personally relevant 6. OCD symptoms may reflect intolerance of uncertainty 7. OCD Related Disorders 1. Hoarding Disorder 1. involves compulsively collecting 2. poor organization skills 3. difficulty discarding 4. cognitive deficits in info processing speed, decision making and procrastinating 2. Excoriation Disorder (skin picking) 1. picking at one's skin, sometimes to point of injury 2. more common among women 3. seen as symptom of autism spectrum disorder 4. infections/healing complications are issues w/ this disorder 3. Trichotillomania (hair pulling) 1. involves person compulsively pulling their hair from their scalp, eyebrows and other body areas 2. can lead to bald spots that person may go to great lengths to disguise 4. Body Dysmorphic Disorder 1. involves distressing preoccupation w/ imagined/slight flaws in physical appearance 2. those w/ it cannot stop thinking about appearance, comparing their appearance to others, checking themselves in mirrors etc 3. occurs about equally in men/women 4. can involve maladaptive behaviors like compulsive exercise and bodybuilding and repeated cosmetic surgery 7. Post-Traumatic Stress Disorder 1. develops through exposure to traumatic event that has overwhelmed the person's abilities to cope 2. events include severely oppressive situation, cruel abuse or natural/unnatural disaster 3. can occur in those who directly experience a trauma , those who witness it and those who only hear about it 4. Symptoms: 1. flashbacks 2. avoidance of emotional experiences and talking about emotions w/ others as well as emotional numbing 3. feelings of anxiety, nervousness, excessive arousal and inability to sleep 4. difficulties w/ memory and concentration 5. impulsive behavior 5. symptoms can occur immediately or after months/years 6. Traumatic events can alter balance of neurotransmitters/hormones and other biological systems 1. PTSD can color the way the body/mind react to stress 7. Factors influencing people's vulnerability to PTSD 1. history of previous traumatic events and conditions 1. ex. abuse and psychological disorders, cultural backgrounds, genetic predisposition 3. Disorders Involving Emotion and Mood 1. Depressive Disorders 1. disorders in which the individual suffers from depression, an unrelenting lack of pleasure in life 2. Major Depressive Disorder (MDD) 1. involves significant depressive episode and depressed characteristics like lethargy/hopelessness for at least 2 weeks 1. impairs daily functioning and has been called the leading cause of disability in the US 2. Symptoms: 1. depressed mood most of the day 2. reduced interest/pleasure in activities that were once enjoyable 3. significant weight loss/gain or decrease/increase in appetite 4. trouble sleeping or sleeping too much 5. fatigue or loss of energy 6. feeling worthless/guilty in an excessive/inappropriate manner 7. problems in thinking, concentrating or decision making 8. recurrent thoughts of death/suicide 9. no history of manic episodes (periods of euphoric mood) 3. Persistent Depressive Disorder 1. individuals experience less extreme depressive moods for over 2 months 2. Symptoms: 1. hopelessness 2. lack of energy 3. poor concentration 4. sleep problems 3. Biological Factors 1. Factors implicated in depressive disorders include: 1. genes 1. may do so in conjunction w/ experiences which suggests vulnerability-stress association 2. brain structure and function 1. depressed individuals show lower levels of brain activity in the section of the prefrontal cortex involved in generating actions and in brain regions associated w/ perception of rewards in the environment 3. neurotransmitters 1. depression likely involves problems w/ neurotransmitter regulation 1. i.e. serotonin, norepinephrine and others 4. Psychological Factors 1. Explanations of depression have drawn on behavioral learning theories and cognitive theories 1. behavioral 1. learned helplessness which spirals into hopelessness 2. cognitive 1. focus on thoughts and beliefs that can contribute/prolong hopelessness 2. automatic negative thoughts reflect illogical self defeating beliefs which shape experiences 1. said thoughts magnify negative experiences 3. Tendency to ruminate on negative experiences/feelings which is associated w/ development of depression 4. focuses also on attributions people make 1. Pessimistic attributional style 1. blaming oneself for negative events/expecting negative events to recur in the future 2. Optimistic attributional style 1. making external attributions for bad things that happen 2. recognize that causes can change and that they are specific 5. Sociocultural Factors 1. low socioeconomic status, especially poverty, are more likely to develop depression 2. women are twice as likely to be diagnosed w/ depression 2. Bipolar Disorder 1. characterized by extreme mood swings that include one or more episodes of mania-an overexcited, unrealistically optimistic state 1. During manic episodes, a person feels 1. euphoric 2. energetic 3. might sleep very little 4. can also feature an impulsivity like spending one's life savings on a foolish business venture 2. Manic episode severity is used to differentiate between the two types of bipolar disorder 1. Bipolar I disorder 1. individuals w/ extreme manic episodes during which they may experience hallucinations 2. Bipolar II disorder 1. milder version in which individual may experience less extreme level of euphoria 3. most w/ bipolar disorder experience multiple cycles of depression mixed w/ mania 4. Factors 1. Genetic Influences 2. High levels of norepinephrine and low levels of serotonin 3. link between high levels of the neurotransmitter glutamate 4. experiences 1. ex. physical, sexual, verbal abuse associated w/ earlier onset of bipolar disorder 2. Disruptive Mood Dysregulation Disorder 1. considered a depressive disorder in children who show persistent irritability and recurrent episodes of out of control behavior 4. Disassociate Disorders 1. Dissociation 1. refers to psychological states in which person feels disconnected from immediate experience 2. Dissociative Disorders 1. psychological disorders that involve a sudden loss of memory or change in identity 2. believed to be individual's way of dealing w/ extreme stress 1. protects their conscious self from traumatic event 3. often occur in individuals showing signs of PTSD 1. thus possibly rooted in extremely traumatic life events 4. lower volume in hippocampus and amygdala in brain's of people w/ dissociative disorders 3. Dissociative Amnesia 1. type of amnesia characterized by extreme memory loss stemming from extensive psychological stress 2. individuals suffering it can remember things like hailing a cab but aspects of their own identity and autobiographical experiences are forgotten 1. some individuals will travel away from home unexpectedly and even assume a new identity 4. Dissociative Identity Disorder (DID) 1. formerly called multiple personality disorder 2. most dramatic, least common and most controversial dissociative disorder 3. individuals w/ this disorder have two or more distinct personalities or identities 1. each identity has its own memories, behaviors and relationships 2. one identity dominates at one time, another takes over at another time 4. Factors are a mystery 1. suggested that a high rate of severe sexual/physical abuse during early childhood is related to the condition 5. Vast majority of people w/ DID are women 6. Some experts believe DID is a social construction 1. it represents a category some people adopt to make sense of their experiences 5. Schizophrenia 1. Psychosis 1. a state in which a person's perceptions and thoughts are fundamentally removed from reality 2. Shizophrenia 1. severe psychological disorder characterized by highly disordered thought processes 1. individuals w/ schizophrenia may see things that aren't there, hear voices in their heads and live in a terrifying world of twisted logic 1. may also say odd things, show inappropriate emotion and move their bodies in weird ways 2. often are socially withdrawn/isolated 2. Usually diagnosed in early adulthood 1. age 18 for men 2. 25 for women 3. Suicide rate is 8x that of the general population 3. Symptoms of Schizophrenia 1. Positive Symptoms 1. involve distortion or an excess of normal function 2. positive because they reflect something added above/beyond normal behavior 3. Include: 1. hallucinations 1. sensory experiences that occur in the absence of real stimuli 2. usually auditory or visual and uncommonly can take the form of smells/tastes 2. delusions 1. false, unusual and sometimes magical beliefs not part of an individual's culture 3. thought disorders 1. unusual sometimes bizarre thought process that are characteristic positive symptoms of schizophrenia 2. thoughts can be disorganized/confused 1. usually has no meaning for a listener 2. individual might make up new words (neologisms) 3. Referential Thinking 1. ascribing personal meaning to completely random events 4. movement disorders 1. unusual mannerisms, body movements and facial expressions that are characteristics of positive symptoms of schizophrenia 2. may be repeated over and over again 1. Catatonia 1. state of immobility/unresponsiveness that lasts for long periods of time. 2. Negative Symptoms 1. reflect social withdrawal, behavioral deficits and the loss/decress of normal functions 2. Flat Affect 1. display of little/no emotion 3. Individuals w/ schizophrenia may show deficient abilty to plan, initiate and enage in goal directed behavior 3. Cognitive Symptoms 1. include deficits in executive functioning 1. difficulty sustaining attention, problems holding info in memory and inability to interpret information 4. Causes of Schizophrenia 1. Biological Factors 1. Genes 2. Structural Brain Abnormalities 1. involve enlarged ventricles 1. fluid filled spaces; enlargement indicates deterioration in other brain tissue 1. changes occur over time suggesting that as schizophrenia progresses the brain deteriorates 2. smaller prefrontal cortext and lower activity in this area 3. Neurotransmitter Regulation 1. problems regulating dopamine play role in schizophrenia 2. glutamate- schizophrenia associated w/ abnormalities in specific types of glutamate receptors 2. Psychological Factors 1. stress may contribute to the development of schizophrenia 3. Sociocultural Factors 1. Not viewed as a cause but as an affect of the course of schizophrenia/its progress 6. Personality Disorders 1. chronic, maladaptive cognitive-behaviroal patterns that are thoroughly integrated into an individual's personality 2. affect a person's sense of self/capacity for relationships w/ others 3. relatively common 4. Antisocial Personality Disorder (ASPD) 1. characterized by guiltlessness, law breaking, exploitation of others, irresponsibility and deceit 2. those w/ ASPD are aggressive/potentially violent 3. far more common in men than woman 4. Characterized by: 1. failure to conform to social norms/obey the law 2. deceitfulness, lying or conning others for personal profit/pleasure 3. Impulsivity 4. irritability/aggressiveness, getting into physical fights/perpetuating assualts 5. reckless disregard for safety of self/others 6. consistent irresponsibility, inconsistent work behavior, not paying bills 7. lack of remorse, showing indifferent to pain of others or rationalizing having hurt/mistreated another 5. linked to low levels of activation in the prefrontal cortex which translate to poor decision making/problems in learning 6. Genetic Factors/childhood abuse associated w/ ASPD 1. evidence that genetic differences may distinguish abused children who go on to commit violent acts from those who don't 7. Individuals w/ ASPD show lower levels of autonomic nervous system arousal and are less stressed by aversive circumstances like punishment 8. Psychopaths 1. subgroup of people w/ ASPD 9. Those w/ ASPD are rarely successfully treated because they are able to con mental health professionals 1. also resist therapeutic relationships because it involves giving up a sense of power/control 5. Borderline Personality Disorder (BPD) 1. pervasive pattern of instability in interpersonal relationships, self image and emotions 2. individuals w/ BPD are insecure and emotional 3. relateed to self harming behaviors like cutting 4. 4 essential features that characterize BPD 1. Unstable affect 2. Unstable sense of self/identity 1. including self destructive impulisive behavior and chronic feelings of emptiness 3. Negative interpersonal relationships which are unstable, intense and characterized by extreme shifts between idealization and devaluation 5. 6. 7. 8. 4. self harm, including recurrent suicidal behavior, gestures or threats/self mutilating behavior To cope w/ unstable emotional life, people w/ BPD may engage in maladaptive behaviors like drinking alcohol/using drugs More common in women than men 1. more common in low income circles and those younger than 30 Causes 1. complex but likely include biological factors/childhood experiences 1. many w/ BPD report various childhood abuses/neglect but it isn't clear if abuse is a primary cause of BPD 1. Abuse may combine w/ genetic factors in promoting BPD 2. Cognitive factiors include: 1. tendency to hold irrational beliefs that one is powerless/innately unacceptable and others are dangerous/hostile 2. Hypervigilance 1. tendency to be constantly on alert, looking for threatening information in the environment 2. displayed in individuals w/ BPD 3. Individuals w/ BPD are very sensitive to how others treat them 1. tend to see world in either/or terms known as Splitting Treatment 1. key aspect of improvement appear to be reducing social stress 7. Suicide 1. Biological Factors 1. Genetic factors 2. # of suicides linked w/ low levels of serotonin and serotonin linked genes 3. poor physical health, especially when chronic, is another risk factor 2. Psychological Factors 1. Psychological disorders and traumatic experiences 1. most common disorders are depression/anxiety 2. Substance abuse linked w/ suicide 3. Interpersonal Theory of Suicide (Thomas Joiner): 1. Suicide involves 2 factors; 1. desire to die 2. acquired capability for suicide 2. Desire to die 1. emerges when person's social needs aren't met 1. feel they don't belong, chronically lonely and perceive themselves to be a burden on others 3. Acquired capability for suicide 1. key variable 2. individuals able to extinguish fear response can accomplish act of suicide 3. Sociocultural Factors 1. lowest rates of suicide occur in countries w/ cultural/religious norms against it 2. nations w/ highest suicide rates Guyana, South Korea, Sri Lanka and Lithuania 3. nations w/ lowest suicide rates Saudi Arabia, Lebanon, Kuwait and Haiti 4. Cultures, economic conditions and ethnic contexts may contribute to suicide risk 1. suicide linked to culture of honor 5. Men are 4x more likely to complete suicide than women 1. Men are more likely to use a firearm while women are more likely to use poison